I read the article in the December 2005 issue by Howie et al1 entitled ‘Venous thromboembolism associated with hip and knee replacement over a ten-year period: a population-based study’ with interest. The authors have found no evidence of improvement in the incidence of venous thromboembolism or of fatal pulmonary embolism with the increased use of DVT chemoprophylaxis in hip and knee arthroplasty. The authors suggest that their data do not imply that anti-thrombotic prophylaxis and earlier mobilisation regimens have no effect. Their data must also imply that the ever-increasing use of chemoprophylaxis has made no difference to the rate of fatal pulmonary embolism. Is the data on length of stay for the hip and knee replacement procedures available over the ten-year period? Their data on day-case and in-patient cataract surgery have shown a significant difference in the venous thromboembolic rate with early mobilisation and discharge.
Early post-operative mobilisation after hip and knee replacements has been accepted as the reason for the decrease in incidence of venous thromboembolic disease. Is it possible therefore, with the data available so far, that we need to pause and review our continuing use of routine DVT chemoprophylaxis for hip and knee replacement surgery?
- © 2006 British Editorial Society of Bone and Joint Surgery